45D2034847 CLIA NUMBER - WALGREENS # 9763

Laboratory Demographics

  • CLIA Code: 45D2034847
  • Facility Name: WALGREENS # 9763
  • Facility Address: 4515 CAMP BOWIE BVLD
    FORT WORTH, TX
    ZIP 76107
  • Facility Phone: 817 735-8185
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DOMINIQUE J. WILLIAMS
  • NPI Number: 1780699876
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2034847
LAB Type Pharmacy
Facility Name WALGREENS # 9763
Street 4515 CAMP BOWIE BVLD
City FORT WORTH
State TX
ZIP 76107
Phone 817 735-8185
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2025
Certificate Expiration Date 6/24/2027
Facility Type Pharmacy
Lab Director DOMINIQUE J. WILLIAMS

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This page was last updated on: 9/29/2025